Comparison On The Curative Effect For Two Types Of Digestive Tract Reconstruction After Total Gastrectomy:A Systematic Review

Objective:Gastric cancer is one of the common malignant tumor in clinical. Total gastrostomy is often used for advanced gastric cancer. The Digestive Tract Reconstruction after Total Gastrostomy should have the effect of anti-reflux. In addition, it should have the function of make food through the normal duodenal physiological channel. This systematic review aims to evaluate the clinical efficacy of Functional Jejuna Interposition surgery (FJI) and Roux-en-Y gastric surgery (RY). Methods:A fully recursive literature search was conducted in PubMed, Cochrane and Ovid electronic library controlled clinical trials database from2000to January2014, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI) and Chinese WanFang Medical Literature Database. Retrieval languages are not restricted. Randomized or quasi-randomized controlled trials of the efficacy of FJI and RY surgery were considered for inclusion. The seven analyzed outcome variables were the incidence of reflux esophagitis, dumping syndrome, early satiety after surgery and patient’s hemoglobin, total protein, weight after surgery. Data related to clinical outcomes were extracted by two reviewers independently. Meta-analysis was performed by RevMan5.2software. Result: Nine published reports of eligible studies involving703participants met the inclusion criteria. The result of meta-analysis showed that:Compared with Roux-en-Y surgery, FJI surgery had significant differences in the incidence of postoperative reflux esophagitis[OR=0.20,95%CCI(0.11,0.35),P<0.00001], postoperative dumping syndrome[OR=0.45,95%CI(0.17,1.17), P=0.10], postoperative early satiety[OR=0.25,95%CI(0.13,0.49), P<0.0001] and patient’s hemoglobin[MD=4.34,95%CI(0.14,8.54), P=0.04], total protein[MD=2.66,95%CI(0.37,4.95), P=0.02], weight[MD=6.33, 95%CI(4.36,8.30), P<0.00001] after surgery. However, there were no significant differences between the two groups in the incidence of diarrhea after surgery [OR=0.45,95%CI(0.17,1.17), P=0.10]. Conclusion:In postoperative complications and nutritional status, Functional Jejuna Interposition surgery is better performance than Roux-en-Y gastric surgery. FJI is a more reasonable way of digestive tract reconstruction.